POS1607 BIOLOGICS THERAPIES FOR PSORIASIS DECREASE FUTURE RISK FOR DEVELOPING PSORIATIC ARTHRITIS
Authors: A. Dotan, N. Ben-Shabat, D. Mcgonagle, H. Amital, A. Watad
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Psoriasis (PsO) is an inflammatory skin disorder with an estimated worldwide prevalence of 2–4% [1]. Psoriatic arthritis (PsA) is highly associated with higher severity of PsO, present in up to 30% of patients and 0.3–1.0% of the global population and PsA typically develops after PsO [1,2]. There are some contradictory studies in relationship to the impact of biological therapies for PsO in relationship to the prevention of PsA. <h3>Objectives</h3> To ascertain whether biological therapies for pre-existing psoriasis (PsO) may reduce the incidence of psoriatic arthritis (PsA) according to different treatment regimens for PsO ranging from topical therapy to biological therapy. <h3>Methods</h3> We conducted a retrospective exploratory study with real-world data from the third largest Israeli health maintenance organization, 'Meuhedet' which covers approximately 1,300,000 subjects. All patients of 'Muehedat' diagnosed with PsO from January 2000 until January 2020 were included in the analysis. Overall, 61,003 patients with PsO were detected. In addition, each PsO patient was paired with four control subjects by gender, age, and ethnicity. Patients diagnosed with PsA before the diagnosis of PsO or less than six months after were excluded from the analysis. We defined PsO according to physicians' diagnoses. PsA included patients with either peripheral or axial arthritis. Patients were classified according to their treatment; Group 1-topical therapy, phototherapy or no therapy, Group 2 - conventional DMARDs (cDMARDs; methotrexate or sulfasalazine), Group 3 -biologics DMARDs (bDMARD) The incident cases of PsA were analyzed according to the aforementioned different lines of therapy. Patients in the bDMARDs group were further sub-grouped according to the first-line prescribed treatment. Time-dependent Cox proportional hazard models were used to evaluate the adjusted risk of developing PsA by treatment group. Data analysis was conducted with Python Software Foundation, Python Language Reference, version 3.9.12, R version 4.2.0, RStudio (RStudio Team, 2020), and the 'Survival' package (v3.2; Therneau, 2020). <h3>Results</h3> 58,671 patients were included contributing a total of 628,228 patient-years. This analysis was adjusted to gender, body mass index (BMI), age of PsO diagnosis, time from psoriasis diagnosis to the group treatment, and number of biological treatments lines. Adjusted Cox proportional hazards regression analysis showed that the risk of developing PsA in PsO patients treated with cDMARDs was significantly higher in comparison to those treated with topical therapy (HR: 2.76, CI: 2.19 – 3.48, p-value: &lt;0.001). On the contrary, the analysis also showed that the risk of developing PsA in PsO patients was significantly decreased in those treated with biological agents in comparison to topical therapy (HR: 0.62, CI: 0.42 – 0.90, p-value: &lt;0.014). <h3>Conclusion</h3> PsO patients treated with cDMARDs are at higher risk of developing PsA in comparison to those treated with topical therapy alone which may reflect the severity of extent of psoriasis in the c DMARD group been linked to PsA. Biological therapy decreased risk of developing PsA in comparison to topical therapy. <h3>References</h3> [1]Mease PJ, Palmer JB, Hur P, Strober BE, Lebwohl M, Karki C, et al. Utilization of the validated Psoriasis Epidemiology Screening Tool to identify signs and symptoms of psoriatic arthritis among those with psoriasis: a cross-sectional analysis from the US-based Corrona Psoriasis Registry. Journal of the European Academy of Dermatology and Venereology 2019;33:886–92. [2]Wilson FC, Icen M, Crowson CS, McEvoy MT, Gabriel SE, Kremers HM. Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: A population-based study. Arthritis Care Res (Hoboken) 2009;61:233–9. [3]Koolaee RM, Takeshita J, Ogdie A. Epidemiology and Natural History of Psoriatic Arthritis: An Update What Dermatologists Need to Know. Curr Dermatol Rep 2013;2:66–76. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.